Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, United States of America.
Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, United States of America.
Am J Emerg Med. 2020 Jun;38(6):1058-1061. doi: 10.1016/j.ajem.2019.158365. Epub 2019 Jul 25.
Laceration closure is one of the most common procedures performed in the emergency department (ED). While sutures and staples have been the traditional wound closure device, topical skin adhesives (TSA) were introduced in the United States 20 years ago as a non-invasive alternative for simple, low-tension wounds. We determined which closure devices were used to close ED lacerations and explored patient and provider characteristics associated with choosing TSA. We also tested the hypothesis that use of TSA would be associated with shorter ED length of stay (LOS) than sutures/staples.
We extracted demographic and clinical data on all patients with a laceration from the publicly available website of the National Hospital Ambulatory Medical Care Survey for the years 2012-2015. This database is provided by the National Center for Health Statistics of the CDC. Based on weighted sampling, national estimates are made for all ED visits in the US. We determined the association between patient characteristics (age, sex, insurance type, geographic location, laceration site, type of ED provider) and use of TSA. We also compared ED LOS between patients whose wounds were closed with TSA or sutures/staples using the t-test and a linear regression model.
There were an estimated 540 million ED patient visits, and 26.1 million patients (4.8%) had at least one laceration. Of the 15.4 million patients with a single laceration, 9.2 million were closed with either sutures/staples (7.2 million), TSA (1.5 million), or both (0.5 million). Mean (SE) age was 30 (1) years, 63% were male and 42% were under age 18 years. Lacerations were on the upper extremity (42%), face (30%), lower extremity (14%) and scalp (8%). Of patients with a single laceration closed with either TSA or sutures/staples, use of TSA did not differ by age, sex, year, geographic location or wound site. ED LOS was significantly shorter in patients whose wounds were closed with TSA (101 ± 7 vs. 136 ± 4 min; P < 0.001). After adjusting for potential confounding variables, use of TSA was associated with a 26 (95% CI 9-44) minute shorter ED LOS (P = 0.004) then sutures/staples.
Topical skin adhesives are used in about 1 of 4 wound closures in the ED. Use of TSA did not differ based on demographic characteristics or wound site. Use of TSA is associated with a shorter ED LOS than sutures/staples.
在急诊科（ED），缝合和订书钉一直是最常用的伤口闭合方法。然而，二十年前，美国引入了一种非侵入性的替代方法——局部皮肤粘合剂（TSA），用于处理简单、低张力的伤口。本研究旨在确定 ED 伤口的闭合方法，并探讨与选择 TSA 相关的患者和医务人员特征。我们还测试了一个假设，即 TSA 的使用与缝合/订书钉相比，与 ED 停留时间（LOS）更短相关。
我们从 2012 年至 2015 年的国家医院门诊医疗保健调查的公共网站上提取了所有有伤口就诊患者的人口统计学和临床数据。该数据库由疾病预防控制中心的国家卫生统计中心提供。基于加权抽样，我们为美国所有 ED 就诊患者提供了全国性估计。我们确定了患者特征（年龄、性别、保险类型、地理位置、伤口部位、ED 提供者类型）与 TSA 使用之间的关联。我们还使用 t 检验和线性回归模型比较了使用 TSA 或缝合/订书钉闭合伤口的患者的 ED LOS。
ED 患者就诊人数估计有 5.4 亿人次，其中 2610 万人次（4.8%）至少有一处伤口。在 1540 万例单处伤口患者中，920 万人次（720 万例）采用缝合/订书钉，150 万人次（1.5 万例）采用 TSA，50 万人次（0.5 万例）采用两者。平均（SE）年龄为 30（1）岁，其中 63%为男性，42%为 18 岁以下。伤口位于上肢（42%）、面部（30%）、下肢（14%）和头皮（8%）。在使用 TSA 或缝合/订书钉闭合的单处伤口患者中，TSA 的使用与年龄、性别、年份、地理位置或伤口部位无关。使用 TSA 闭合伤口的患者 ED LOS 明显短于使用缝合/订书钉（101±7 分钟 vs. 136±4 分钟；P<0.001）。调整潜在混杂变量后，TSA 的使用与 ED LOS 缩短 26（95%CI 9-44）分钟相关（P=0.004），而缝合/订书钉无此效果。
TSA 在 ED 伤口闭合中约占 1/4。TSA 的使用与人口统计学特征或伤口部位无关。与缝合/订书钉相比，TSA 的使用与 ED LOS 更短相关。
